Under Obamacare, more and more doctors are becoming employees of large hospitals, where there will be more control over how they practice medicine. Hoover Institution Senior Fellow Dr. Scott Atlas fears this will cause a brain drain in medicine. "Really smart people want autonomy, and when you take that away it's naive to think you're going to get really bright people becoming doctors," says Atlas. "The best doctors could excel at any profession, so why go into medicine if they won't have the opportunity to be their best?"

Funny, that quote looks like something right out of the book/film Atlas Shrugged, and the guy's name is Atlas.

Obamacare official: “Let’s just make sure it’s not a third-world experience”

March 22, 2013 | 11:11 am 135Comments114Share on printShare on email

Philip Klein

Senior Editorial WriterThe Washington Examiner

With time-running out before the major provisions of President Obama’s health care law are set to be implemented, the official tasked with making sure the law’s key insurance exchanges are up and running is already lowering expectations.

“The time for debating about the size of text on the screen or the color or is it a world-class user experience, that’s what we used to talk about two years ago,” Henry Chao, an official at the Centers for Medicaid and Medicare Services who is overseeing the technology of the exchanges said at a recent conference. “Let’s just make sure it’s not a third-world experience.”

Chao also described himself as “nervous.” His comments, which came at a policy meeting of insurance industry lobbying group America’s Health Insurance Plans, were first reported by CQ Health Beat and picked up by Avik Roy at Forbes.

The idea of regulated insurance exchanges, on which eligible individuals can use government subsidies to purchase insurance coverage, is central to the law. By 2023, the Congressional Budget Office projects that 25 million Americans will obtain coverage through the exchanges.

As originally pitched, the exchanges were to be easy to use — like Expedia or Orbitz for health insurance — allowing users to fill out basic information, have the government database verify their eligibility, and then enable them to choose among competing plans.

But achieving this has been proving to be a huge hurdle. The exchanges are supposed to be available for open enrollment by Oct. 1 and benefits are supposed to kick in on January 1. Also adding to the workload — 26 states have chosen to let the federal government set up their exchanges.

The CQ article also quotes Gary Cohen, director of the federal Center for Consumer Information and Insurance Oversight, as conceding that the exchanges may not be fully functional in all 50 states in time. “I think it’s only prudent to not assume everything is going to work perfectly on day one and to make sure that we’ve got plans in place to address things that may happen,” Cohen said.

SAN DIEGO — Dr. Ted Mazer is one of the few ear, nose and throat specialists in this region who treat low-income people on Medicaid, so many of his patients travel long distances to see him.

But now, as California’s Medicaid program is preparing for a major expansion under President Obama’s health care law, Dr. Mazer says he cannot accept additional patients under the government insurance program for a simple reason: It does not pay enough.

“It’s a bad situation that is likely to be made worse,” he said.

His view is shared by many doctors around the country. Medicaid for years has struggled with a shortage of doctors willing to accept its low reimbursement rates and red tape, forcing many patients to wait for care, particularly from specialists like Dr. Mazer.

Yet in just five weeks, millions of additional Americans will be covered by the program, many of them older people with an array of health problems. The Congressional Budget Office predicts that nine million people will gain coverage through Medicaid next year alone. In many of the 26 states expanding the program, the newly eligible have been flocking to sign up.

Community clinics, which typically provide primary but not specialty care, have expanded and hired more medical staff members to meet the anticipated wave of new patients. And managed-care companies are recruiting doctors, nurse practitioners and other professionals into their networks, sometimes offering higher pay if they improve care while keeping costs down. But it is far from clear that the demand can be met, experts say.

In California, with the nation’s largest Medicaid population, many doctors say they are already overwhelmed and are unable to take on more low-income patients. Dr. Hector Flores, a primary care doctor in East Los Angeles whose practice has 26,000 patients, more than a third of whom are on Medicaid, said he could accommodate an additional 1,000 Medicaid patients at most.